North Carolina Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in North Carolina, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This North Carolina billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
North Carolina billing guide: how North Carolina pays for outpatient care
NC Medicaid, run by the Department of Health and Human Services, delivers care through four Standard Plans and four Behavioral Health I/DD Tailored Plans. Standard Plans cover basic behavioral health. Tailored Plans serve members with serious mental illness, severe substance use disorder, intellectual or developmental disabilities or traumatic brain injury. Bill the plan the member is enrolled in.
NCTracks is the claims and enrollment system for NC Medicaid Direct, the fee-for-service program that still covers some members. Starting January 1, 2027, most adults 19 to 64 must meet a work and community engagement requirement.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | NCDHHS NC Medicaid; four Standard Plans and four Tailored Plans; NCTracks | NC Medicaid health plans |
| Medicare Part B | Palmetto GBA, Jurisdiction M | CMS MAC page |
| Blue Cross Blue Shield | Blue Cross and Blue Shield of North Carolina | See the Blue Cross section below |
North Carolina Medicaid: NC Medicaid
This North Carolina billing guide starts with Medicaid, because it decides who pays and how you file.
Standard Plans offer physical health, pharmacy, care management and basic behavioral health. Tailored Plans started July 1, 2024 and manage behavioral health for members with serious mental illness, severe substance use disorder, I/DD or traumatic brain injury. Some members, such as those on the Innovations and TBI waivers, must be in a Tailored Plan. Providers must be in the member's plan network to be paid.
WellCare, which some older sources list as a Standard Plan, does not appear on the current NC Medicaid health plans page.
| Item | What to know |
|---|---|
| Agency | NC Department of Health and Human Services, NC Medicaid |
| Claims and enrollment | NC Medicaid claims and billing through NCTracks. Most Medicaid claims must be filed electronically. |
| Filing window | Managed care plans accept medical claims for 365 calendar days from the date of service. NC Medicaid Direct claims must be received within 365 days of the first date of service. Provider Playbook fact sheet |
| Prompt payment | Clean medical claims are paid or denied within 30 calendar days of becoming clean, with 18 percent annual interest on late claims. Source |
| Outpatient behavioral health policy | Clinical Coverage Policy 8C lists eligible providers, including physicians, licensed psychologists, LPCs, LCSWs, LMFTs and LCASs. Providers must be NC-licensed and directly enrolled, and cannot bill incident to. |
| Work requirement | Starting January 1, 2027, most adults 19 to 64 must meet the work and community engagement requirement. NC Medicaid lists exemptions for people with a substance use disorder, a disabling mental disorder, or in addiction treatment. Source |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| AmeriHealth Caritas North Carolina | Standard Plan, statewide. |
| Healthy Blue of North Carolina | Standard Plan, statewide. |
| UnitedHealthcare of North Carolina | Standard Plan, statewide. |
| Carolina Complete Health | Standard Plan in Regions 3, 4 and 5. |
| Alliance Health, Partners, Trillium and Vaya | Behavioral Health I/DD Tailored Plans, assigned by the county that administers the member's Medicaid. |
See the NC Medicaid Tailored Plans page for the plan that serves each county.
Medicare Part B in North Carolina
For Medicare, this North Carolina billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | Palmetto GBA, LLC |
| Jurisdiction | Jurisdiction M: North Carolina, South Carolina, Virginia and West Virginia |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in North Carolina
This part of the North Carolina billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. In North Carolina the main Blue plan is Blue Cross and Blue Shield of North Carolina. It is separate from Anthem. Healthy Blue of North Carolina is a Medicaid Standard Plan on the NC Medicaid list, not a commercial plan. Do not apply another state's Blue rules to Blue Cross NC.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Blue Cross and Blue Shield of North Carolina | Separate from Anthem | North Carolina | Blue Cross NC provider site |
Other private payers and EAPs in North Carolina
The North Carolina billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in North Carolina. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Blue Cross and Blue Shield of North Carolina | Check the Blue Cross NC provider site for the current commercial filing limit and behavioral health arrangement before you bill. | Official page |
| Healthy Blue of North Carolina (Medicaid) | Medicaid Standard Plan. Its timely filing document, dated June 2024, states 365 days. | Official page |
North Carolina billing guide: state law that changes billing
Use this section of the North Carolina billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in North Carolina. Medicare and Medicaid rules are covered in their own sections above.
Prompt claim payment
N.C. Gen. Stat. 58-3-225 requires insurers to pay, deny or send a required notice within 30 calendar days of receiving a claim, with 18 percent annual interest on late payments. Insurers may require submission within no less than 180 days of care. Statute
Chemical dependency coverage
N.C. Gen. Stat. 58-51-50 requires chemical dependency benefits no less favorable than physical illness benefits, and federal parity compliance for large-employer group plans. Statute
Medicaid parity alignment
NC Medicaid revised its behavioral health clinical coverage policies effective January 1, 2025 to remove unit and visit caps and most prior authorization language, to align with federal parity. Source
Telehealth in NC Medicaid
Clinical Coverage Policy 1-H says to bill with the provider's usual place of service, use modifier GT for audio-visual services, and that GT services pay the fee schedule amount. Psychological testing under 8C must be in person. Policy
Not legal advice. Confirm statute details with counsel.
North Carolina billing guide: codes and rates
This North Carolina billing guide lists only codes and rates confirmed on official pages.
These are the North Carolina-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| Telehealth modifier GT | Policy 1-H: modifier GT for interactive audio-visual services, with the provider's usual place of service. Audio-only psychiatric services use codes 98008 to 98016. Source |
| 2025 policy revisions | Policies 8A, 8C, 8D-1, 8D-2 and others were revised January 1, 2025 to remove unit caps and most prior authorization language. Recheck the live text of 8C before you cite any visit limit. Source |
| Rate reductions | NC Medicaid fee schedule reductions took effect October 1, 2025. A bulletin published December 10, 2025 replaced the earlier version, so check the current bulletin for percentages. Source |
North Carolina billing guide: what changed, newest first
Check this North Carolina billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2027-01-01 | NC Medicaid work and community engagement requirement begins for most adults 19 to 64. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2025-12-10 | NC Medicaid published an updated rate reduction bulletin that replaced the October 30, 2025 version. | Source |
| 2025-10-01 | NC Medicaid fee schedule rate reductions took effect. | Source |
| 2025-01-01 | Revised behavioral health clinical coverage policies took effect. | Source |
| 2024-07-01 | Behavioral Health I/DD Tailored Plans started, and Tailored Plans and NC Medicaid Direct moved to 365-day timely filing. | Source |
How do I bill mental health claims in North Carolina?
These answers come from the same sources as the rest of this North Carolina billing guide.
Start with the member's plan type. For NC Medicaid, bill the Standard Plan for basic behavioral health, or the Tailored Plan for members with serious needs. Managed care plans accept claims for 365 calendar days from the date of service. Medicare Part B goes to Palmetto GBA in Jurisdiction M.
Questions about billing in North Carolina
Who do I bill for NC Medicaid behavioral health claims?
Bill the member's Standard Plan for basic behavioral health, or the Tailored Plan for members with serious mental illness, severe substance use disorder, I/DD or traumatic brain injury.
What is the NC Medicaid timely filing limit?
365 days from the date of service for managed care and NC Medicaid Direct claims, according to the NC Medicaid Provider Playbook.
What changed for NC Medicaid behavioral health in 2025?
Revised clinical coverage policies took effect January 1, 2025, and fee schedule reductions took effect October 1, 2025, with an updated bulletin on December 10, 2025.
When does the NC Medicaid work requirement start?
January 1, 2027 for most adults 19 to 64, with exemptions that include a disabling mental disorder and substance use disorder.
Does MCM South bill for practices in North Carolina?
MCM South serves North Carolina. Request a quote to talk through your practice.
Sources for the North Carolina billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- NC Medicaid health plans, checked October 25, 2026
- NC Medicaid Tailored Plans, checked October 25, 2026
- NC Medicaid claims and billing, checked October 25, 2026
- NC Medicaid Provider Playbook prompt payment fact sheet, checked October 25, 2026
- NC Medicaid work and community engagement requirements, checked October 25, 2026
- NC Medicaid rate reductions, October 2025, checked October 25, 2026
- NC Medicaid behavioral health policy updates, checked October 25, 2026
- Clinical Coverage Policy 8C, checked October 25, 2026
- Clinical Coverage Policy 1-H, checked October 25, 2026
- N.C. Gen. Stat. 58-3-225, checked October 25, 2026
- N.C. Gen. Stat. 58-51-50, checked October 25, 2026
- CMS: Jurisdiction M, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- North Carolina insurance companies contact guide
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for North Carolina
- North Carolina Medicaid billing codes
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Georgia insurance companies contact guide
Billing in North Carolina? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We serve North Carolina.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.